131: Alcohol, Pregnancy and Breastfeeding: No Shame, No Myths, Just Biology

Alcohol, pregnancy and breastfeeding are surrounded by myths, slogans and a fair amount of internet nonsense. In this episode, Afif and Anne look at what alcohol actually does before conception, during pregnancy and while breastfeeding. They discuss paternal alcohol exposure, fetal alcohol spectrum disorder, the “sober enough to feed” slogan, pumping and dumping, beer and milk supply, and the misleading comparison between breastmilk and orange juice. No shame, no panic, just biology. Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

SPEAKER_00 0:01

This show is part of the Headstuff Podcast Network.

SPEAKER_02 0:15

Welcome to the Baby Tribe. I'm your host, Afi Felkafash, Neonatologist, Pediatrician and Lactation Consultant, and my co-host is Anne Doherty, obstetric anesthesiologist. Alcohol and parenting is one of those topics where everybody suddenly becomes a pharmacologist after one glass of wine and an Instagram reel. During pregnancy, we have somehow turned a known fetal toxin into a lifestyle debate. During breastfeeding, the reassurance can even get stranger. If you're sober enough to hold your baby, you're sober enough to feed your baby. I get the intention. It's meant to reduce panic and shame, but as medical advice, it's doing a lot of heavy lifting for a slogan. Holding a baby is about coordination. Feeding after alcohol is about pharmacology. Blood alcohol, milk alcohol, timing, infant metabolism, sleep, feeding, milk supply, and safe caregiving. So today we're not here to shame anyone. One drink is not a moral collapse, but we are also not going to pretend alcohol becomes harmless because the internet found a catchy sentence. We're gonna talk about alcohol and conception, alcohol and pregnancy, fetal alcohol spectrum disorder, and what actually happens during breastfeeding. No panic, no myths, just biology. Welcome to the baby tribe. I'm Afi Velkafash, and as always, my co-host is my better half, Anne Doherty. Hello Anne, how are you?

SPEAKER_03 1:31

Hello, Afife. Hello, listeners. How are you?

SPEAKER_02 1:33

Anne is very chilled today because we had a lovely walk in the sunshine.

SPEAKER_03 1:38

It's a really sunny day. It's lovely and warm. I actually feel like life is good. Yeah. It's an amazing it's amazing the way the little bit of sun totally just transforms my mood. It's terrible.

SPEAKER_02 1:50

And I'm just thinking, this is the first time we record in shorts. It's like we're exotic or something.

SPEAKER_03 1:54

I know. I know. It's like it's like we have a climate.

SPEAKER_02 1:57

And Buddy's sitting right beside me, so if you hear a growl every now and again, that's that's that's Buddy asserting himself as part of the podcast. Yes, and also he doesn't like flies, so he gives that to them when he sees them. I was thinking Buddy was with us on the walk, and he would be great for pulling.

SPEAKER_03 2:15

Like pulling women.

SPEAKER_02 2:18

Like the number of women that just stop and chat.

SPEAKER_03 2:22

This is this is where your thought process goes. Somebody admires the dog, and you're just like, or thinks the dog is cute, and you think it's somehow an in for you.

SPEAKER_02 2:32

Honestly, guys, forget dating apps.

SPEAKER_03 2:34

I think people are just learning. If you see a fief in the in the park with Buddy, do not approach him. That's what people are hearing. Do not approach him because he sees it as some weird, dodgy opportunity.

SPEAKER_02 2:45

I'm just saying, of course, I will not capitalise on that because I am happily married.

SPEAKER_03 2:49

I can't believe that the thought process went through your head. Like I'm here going, Oh, it's such a lovely day. This is so nice, so wholesome in the park chatting to people, but he's cute, people he makes people happy. This is nice. And a thief thinks, what an opportunity.

SPEAKER_02 3:04

I'm thinking, what a potential opportunity. Oh you know that I would never ever cheat on you.

SPEAKER_03 3:09

No, because you're afraid.

SPEAKER_02 3:10

Yes.

SPEAKER_03 3:11

Yeah.

SPEAKER_02 3:13

I'm afraid.

SPEAKER_03 3:14

I'm okay with that.

SPEAKER_02 3:16

Yeah.

SPEAKER_03 3:17

I'm fine that you're terrified. That's good.

SPEAKER_02 3:19

Fear is better than love in terms of preventing marital disharmony. And keeps reminding me of ways that she can kill me in a very undetectable way.

SPEAKER_03 3:26

Well, Anissa, this anesthesia is like applied pharmacology. That's essentially what it is.

SPEAKER_02 3:31

Yeah, yeah. Care to share a couple of methods?

SPEAKER_03 3:33

No.

SPEAKER_02 3:34

One one she always tells me is the little injection of insulin between your toes.

SPEAKER_03 3:38

No, that's everyone knows about that.

SPEAKER_02 3:40

Oh, everyone knows about that one. What about other undetectable ways?

SPEAKER_03 3:43

Not talking.

SPEAKER_02 3:45

Yeah, guys, you can see how scary um marrying Anne is. But anyway.

SPEAKER_03 3:50

No, no, no. You can see how scary straying from marriage to Anne would be. Marrying me was a joy.

SPEAKER_02 3:58

Sorry, that's yeah. Let's be clear here. Yeah, I know. It is. It is a joy. And look, we work together.

SPEAKER_03 4:06

Yes.

SPEAKER_02 4:07

We live together.

SPEAKER_03 4:08

Yes.

SPEAKER_02 4:08

Yeah.

SPEAKER_03 4:09

We podcast together.

SPEAKER_02 4:11

We podcast together.

SPEAKER_03 4:13

We are happily married.

SPEAKER_02 4:14

We are happily married.

SPEAKER_03 4:15

In fact, in fact. She says threateningly.

SPEAKER_02 4:18

Yeah. On our walk, we I was chatting about this. You can do this 130-day cruise around the world.

SPEAKER_03 4:23

Oh, that's what a dream.

SPEAKER_02 4:24

Sounds incredible. It's going on the bucket list.

SPEAKER_03 4:27

It's going on the bucket list, absolutely. Yeah, it has to be. And if the Wi-Fi is good, we can podcast as we go.

SPEAKER_02 4:32

Imagine. Yeah. We can do parenting parenting around the world.

SPEAKER_03 4:35

That'd be so good.

SPEAKER_02 4:37

Yeah, but you'll have to up your um Instagram game.

SPEAKER_03 4:41

Can I not just pick you back on your Instagram, Mike?

SPEAKER_02 4:43

Yeah, exactly. Yeah, we'll have to do cute husband and wife um Instagram stuff.

SPEAKER_03 4:48

I'll tell you what, you can negotiate my presence on your Instagram page rather than doing the little covert 3D printing things that you're randomly doing right now. I see what you're doing.

SPEAKER_02 4:57

Hey, the printer's not working.

unknown 4:59

I know, I'm so happy.

SPEAKER_02 5:00

It's the first time it actually hasn't been printing while we're recording in about a month. So um yeah.

SPEAKER_03 5:05

So I'm sure you'll remedy that.

SPEAKER_02 5:07

I will. Anyway, today we're talking about a topic that can create controversy, can create vocal opinions on Instagram, and that is alcohol consumption and parenting in general.

SPEAKER_03 5:28

Yeah.

SPEAKER_02 5:29

And the reason I thought it's timely to do it is for several reasons. Number one, weather's nice, people want to be part of the social scene.

SPEAKER_03 5:38

Outdoors season.

SPEAKER_02 5:40

Apriol spritz outdoor season. You might be thinking about conceiving, you might be pregnant, you might be breastfeeding, and you're wondering what is the science behind alcohol in all of these situations.

SPEAKER_03 5:50

Yeah, fair.

SPEAKER_02 5:51

Number two, there is a bit of a creep on social media trivializing the consumption of alcohol during crucial phases of parenting, basically.

SPEAKER_03 6:01

Okay.

SPEAKER_02 6:02

That have, I think, given the green light to a lot of people to think, okay, I can not worry about drinking.

SPEAKER_03 6:09

Okay.

SPEAKER_02 6:10

Now, I want to be careful here and say we're not saying that you shouldn't drink in certain situations, but you should know the science.

SPEAKER_03 6:18

What we're saying is that like people should not be sitting down fretting. People should be objectively informed, yeah. So they can assess their own situation and make informed decisions as adults.

SPEAKER_02 6:31

I'm hearing a lot of slogans.

SPEAKER_03 6:32

Everybody loves a good slogan.

SPEAKER_02 6:34

Yes, especially around breastfeeding and alcohol. You know? Okay. Things like if you're sober enough to hold your baby, you're sober enough to feed your baby. And I and I'll talk about why I don't like that one once we get to the breastfeeding part of the chat. The other one I don't like is the equivalency of the percentage of alcohol present in breast milk after a few drinks and the similar to the percentage of alcohol present in juice, trivializing that percentage. Yes. And we'll talk about that as well. So, but let's let's actually go back and talk about the biology of alcohol and why it can be potentially harmful.

SPEAKER_03 7:08

Yeah, okay, fine.

SPEAKER_02 7:10

So alcohol or ethanol is a small molecule that is biologically very mobile, meaning that it can cross pretty much all the membranes.

SPEAKER_03 7:20

It's pretty soluble.

SPEAKER_02 7:21

Pretty soluble. So once it enters the bloodstream, it can cross the placenta.

SPEAKER_03 7:26

Yeah.

SPEAKER_02 7:26

Get into the fetus, it passes into breast milk, obviously crosses into your brain.

SPEAKER_03 7:31

Yes. So it's one of the yeah, it crosses the blood-brain barrier. Yeah. Which is why you feel drunk.

SPEAKER_02 7:37

Yes.

SPEAKER_03 7:38

If you consume a certain amount. And it's in the same as everything that we consume, there's a dose.

SPEAKER_02 7:44

Yeah. What happens to alcohol is that it's broken down or metabolized in the liver to acetaldehyde. And that is a toxic and reactive metabolite.

SPEAKER_03 7:53

Yeah.

SPEAKER_02 7:54

In bigger, in big quantities.

SPEAKER_03 7:55

Yeah. So it's it's a neurotoxin.

SPEAKER_02 7:59

Yes.

SPEAKER_03 8:00

So that's why people who um might have abused alcohol or taken high doses of alcohol for a prolonged period of time, they can get what we call neuropathies. So they can lose sensation in their hands and feet and all that kind of stuff. Peripheral neuropathies associated with that. Um it's a liver toxin.

SPEAKER_01 8:20

Yeah.

SPEAKER_03 8:21

So it it it damages your liver over a prolonged period of time. It's a cardiac toxin as well, actually. It can it can really affect your heart function over long periods of time. But all of these things are with prolonged high dose use. Yes. And that's the difference.

SPEAKER_02 8:39

Yes, it also can lead to mitochondrial dysfunction.

SPEAKER_03 8:43

Okay, so people need to understand what the mitochondria is.

SPEAKER_02 8:46

So tell us.

SPEAKER_03 8:47

So the mitochondria is this little inside your cell, there's a little, there's little structures called organelles. And it's funny because it's thought that mitochondria were actually separate organisms that actually moved into a cell, another organism, and then they started acting synergistically together way, way back billions of years ago, that actually helped create multicelled life on Earth. So mitochondrias essentially are they have their own DNA, they produce energy super efficiently for your cell to function, and in exchange, we feed them. Yeah. And that's how it works. But they are a part of us, and everybody gets their mitochondria entirely from their mother. And in sports medicine, that's why if some family is really super duper sporty and seemed to have this genetic component where they can do like long-distance cycling and stuff like that, they look for the children of the mother of the one of the females of that generation. Wow. Because they inherit the mitochondria.

SPEAKER_02 9:53

Wow, that's incredible. That's your mitochondria. Yeah. So it can cause dysfunction in that, it can also cause altered cell signaling, cell death, and it can actually lead to epigenetic changes, which will be relevant in a second.

SPEAKER_03 10:04

Yeah, so epigenetic changes. Yeah. Okay. So there's lots of different ways that the environment modify your existing DNA. And one of them is is through adding a methyl group onto your DNA. Um, and it's it's like it basically tags your genes essentially, and it influences how they're expressed as a result. And that's what epigenetic changes are. It's changes to your it's tags added onto your DNA, and by tags I don't mean like actual physical tags, I mean like it's additional information imposed on your DNA to influence how that gene is expressed.

SPEAKER_02 10:43

We've talked about how the microbiome can influence that significantly. Yeah. So with all of these things, you might wonder, gosh, how are we surviving drinking alcohol in a growing fetus where the fetus is not just growing bigger, they're building organs, migrating neurons, they're forming craniofacial structures, wiring the brain, programming long-term physiology. When there is a time of active change, that's when alcohol can be most harmful and impactful.

SPEAKER_03 11:12

Well, I suppose if you look at it from the perspective of your genes, like the genetic material is dictating how those cells are to develop into organs, into tissues, and then into organs and then into organ systems. Yeah. So if you're starting to suboptimally influence the development of that cell signaling and that DNA signalling already, it's going to have a much more widespread effect.

SPEAKER_02 11:39

Yes. And we're going to talk about those effects in a little while. But I thought we'd bring it back to a time where people do not think that alcohol may have an impact, and that's around the time of conception.

SPEAKER_03 11:48

Yeah, that's actually and preconception, actually.

SPEAKER_02 11:51

Yes, sorry, I meant preconception.

SPEAKER_03 11:53

Pre-conception. So for both men and women.

SPEAKER_02 11:55

For both men and women. But I want to focus particularly on men because there's this myth that it's only women that should abstain around the time of conception or trying to conceive.

SPEAKER_03 12:05

Yeah.

SPEAKER_02 12:06

So historically, the conversation focused almost entirely on maternal pregnancy exposure.

SPEAKER_03 12:13

Yeah, because again, historically and sociologically, women carry the can for all of this. Yeah. And anything like when you think about pre-screening, pre-genetic screening, all of this kind of stuff, any negative outcomes related to pregnancy was the responsibility of the woman and the woman alone.

SPEAKER_02 12:30

Yes.

SPEAKER_03 12:31

And we now know this not to be true.

SPEAKER_02 12:33

Absolutely. So um human sperm development takes roughly two to three months. Yeah. The turnover. So um there has been studies showing that alcohol exposure in this time period before conception may actually affect the sperm involved in conception.

SPEAKER_03 12:50

Yeah.

SPEAKER_02 12:51

And why? Because sperm is not just a DNA delivery drone, but it also has signals that influence early embryo development, placental development. It can actually have epigenetic marks.

SPEAKER_03 13:02

So interestingly, like the if when you think about the placenta, um, it's development obviously is coded for genetically, okay, because everything that develops as part of our being is coded for in our genes, right? Yeah. But we get two copies of most things, one from the mum and one from the dad. Yes. And it's actually the dad's imprinted genes that actually code for development of the placenta. Yes. Um, so yeah, that would make sense.

SPEAKER_02 13:31

Yeah, so there was a prospective study done recently assessing the parental alcohol consumption during the last three months before conception, and found associations, no, not cause and effect, but associations between alcohol consumption and behavioral issues in children ages four to six. And obviously the authors were cautious to say that look, this needs to be replicated, but there is biological plausibility there.

SPEAKER_03 13:56

Okay, but let's, you know, you're always talking about effect size and things like that. Like how much of a worry is this?

SPEAKER_02 14:04

Not not much, but enough to be just mindful of maybe consumption around the time of uh conception.

SPEAKER_03 14:12

Now, in fairness, there have been lots of people all throughout history who get pregnant um on a great night out that involves drinking alcohol. Yeah, absolutely. People have been absolutely fine. So that's the corollary of that.

SPEAKER_02 14:25

Yes. I mean, if you want to be purist about it, um, if you are trying to conceive, give sperm a clean three-month runway.

SPEAKER_03 14:32

That would be the kind of ideal advice to if you want to go down to the minutiae, yeah.

SPEAKER_02 14:38

Yeah, exactly.

SPEAKER_03 14:39

But it's ideally have some awareness of limiting exposure, potentially. Yeah, I mean in the same way as a woman would ideally have some awareness of limiting exposure.

SPEAKER_02 14:49

Yeah. Now, where we have the biggest evidence and and I guess the ability to give the strongest advice is alcohol during pregnancy.

SPEAKER_03 14:57

Yes.

SPEAKER_02 14:57

So during pregnancy, we know that alcohol passes from the maternal blood to the fetal blood through the placenta. There are some whispers out in social media saying that the placenta filters alcohol, it doesn't.

SPEAKER_03 15:10

It doesn't, because it yeah, it it doesn't. The problem is it doesn't metabolize alcohol. Your liver is the only thing that metabolizes the alcohol out of your system.

SPEAKER_02 15:18

And the thing that you have to remember, in addition to all the effects alcohol may have in terms of its toxicity on the developing organ cells and all of that in the fetus, they lack the ability to break down and metabolize alcohol, so they're dependent on the mother to clear it.

SPEAKER_03 15:33

Yeah.

SPEAKER_02 15:33

So the fetus cannot. So the exposure may be a little bit more prolonged and more biologically active in the fetus.

SPEAKER_03 15:40

Theoretically.

SPEAKER_02 15:41

Yes, because once they alcoholic.

SPEAKER_03 15:42

You can't really study that.

SPEAKER_02 15:44

Yes, but once the alcohol gets to the fetus, they're not metabolizing it. The thing that we worry about, and I think that the the condition that people are aware of is fetal alcohol syndrome. Fetal alcohol syndrome is kind of the most severe subtype of a condition called fetal alcohol spectrum disorder.

SPEAKER_03 16:04

Yes.

SPEAKER_02 16:05

FASD, fetal alcohol spectrum disorder, it's an umbrella term and it can include non-physical effects. So you can't see the typical facial features that you may see on an individual that may have fetal alcohol syndrome. So you may still have cognitive and behavioral issues, emotional, adaptive functional problems.

SPEAKER_03 16:26

I do think though that that kind of very inaccurate, like imprecise umbrella term of you know, vague, potentially like um behavioral or IQ issues and stuff like that. Like there's a whole host of small point mutations that have nothing to do with alcohol, yes, that will actually come under all of those terms. So I do think that people get vilified, people who've l very limited or like very, very little exposure in terms of alcohol consumption in pregnancy. Um, and it could be something that happened before they knew they were pregnant.

SPEAKER_01 17:10

Yeah.

SPEAKER_03 17:10

And then all of these like vague kind of where where somebody's obviously shown some signs of impairment, and then it comes back down to what exposure to alcohol do they have. So I just think that we have to be really careful on that.

SPEAKER_02 17:25

Absolutely.

SPEAKER_03 17:26

We really, really do, because there's a whole host of very small minor mutations that have nothing to do with alcohol that will present that way. So uh I just think that people can get really holed across the coals with that.

SPEAKER_02 17:38

They can, and I think it is important, as you said, to strike a balance of acknowledging that alcohol may cause issues to the fetus during pregnancy, while also acknowledging that those behavioural, developmental, cognitive issues are so multifactorial.

SPEAKER_03 17:56

Absolutely. And environment plays a huge role, but also like virus exposure, you can't stop yourself getting a virus by accident. Absolutely. Like all of those things, there's a huge amount of factors that influence it.

SPEAKER_02 18:08

Yeah. Fetal alcohol syndrome, the extreme end of the spectrum, is readily identifiable.

SPEAKER_03 18:15

Yes, but the rest of it then gets very murky.

SPEAKER_02 18:19

And just to kind of put it in perspective, there was a JAMA pediatrics systematic review that estimated that FASD prevalence among children is around eight per 1,000 on average globally. In Ireland, it's up to 50 per 1,000. It's one of the highest internationally. I have to say, I think that the level of consumption of alcohol during pregnancy now has gone down significantly.

SPEAKER_03 18:48

To be honest, people for the longest time were not. Do you remember? Like the joke could be like, oh, you know, I better tell them I'm on antibiotics because I don't want to tell them I'm pregnant yet, and they'll be wondering why I'm not drinking.

SPEAKER_02 18:59

Why I'm not drinking, yeah, exactly.

SPEAKER_03 19:01

People have abstained from alcohol in pregnancy for a very long time. I don't think it's been expected for a long time that people would be drinking alcohol while pregnant to any significant degree.

SPEAKER_02 19:15

Yeah, but it still does happen.

SPEAKER_03 19:16

It still does happen. It is a it is a choice.

SPEAKER_02 19:19

Again, that's why there's a lot of nuance. So just to summarise what we've spoken about so far, um, consuming alcohol during conception for mum and dad, um you can't give a um definite advice on that, but I would advise caution given the recent data that has come out. Yeah, okay. Alcohol during pregnancy, the I can definitively say the safest thing is to abstain during pregnancy.

SPEAKER_03 19:44

So it's fair.

SPEAKER_02 19:45

Right. And there is no agreed safe level of alcohol consumption during pregnancy. I'm not saying that there isn't one, there isn't an agreed one or a recognized one because it's so individual.

SPEAKER_03 19:58

Yeah, that's fair.

SPEAKER_02 20:09

Now on to breastfeeding.

SPEAKER_03 20:11

This is where it actually gets contentious, and I know it sounds like it's it's been contentious thus far in some ways.

SPEAKER_01 20:18

Yes.

SPEAKER_03 20:18

But um it's just because like for somebody like I enjoy a glass of wine. Um now when I was breastfeeding the kids, I wasn't drinking pretty much at all. Um partly because I was wrecked and partly because we were in a variety of different places that didn't have a huge amount of support, so it was not really an option. But um I just I just think that there has to be optimal timing on that so that people can have options.

SPEAKER_02 20:55

There is pregnancy and breastfeeding are not the same biological situation.

SPEAKER_03 20:58

Absolutely.

SPEAKER_02 20:59

So in pregnancy, alcohol is directly exposing a developing fetus during organ formation.

SPEAKER_03 21:05

Because you're continuously supplying them with your blood.

SPEAKER_02 21:07

Yes. In breastfeeding, there are transfer biology. There is transfer biology number one from blood to milk in the mother, number two from milk to baby.

SPEAKER_03 21:21

Yes.

SPEAKER_02 21:21

Okay, so there are a few different physiological steps that we need to talk about.

SPEAKER_03 21:26

Yes, and I think that's a good logical way to address it.

SPEAKER_02 21:29

Yeah. So when a breastfeeding mother consumes a glass of wine equivalent to one unit of alcohol, what actually happens? Your blood alcohol level, and it's very variable, but your blood alcohol level after that one drink peaks between 60 to 90 minutes after you consume, and by two hours, two and a half hours after you consume that glass of wine, it is pretty much gone from your system. Yes. Now, before I go on, there are a lot of caveats. Consuming food can delay that curve. Body habitus, genetics, a lot of things can impact that curve.

SPEAKER_03 22:06

It's not It's not a guarantee.

SPEAKER_02 22:08

It's not a guarantee, but that's the general gist of it, right?

SPEAKER_03 22:11

Yeah, and also how much is one glass? Like, Jesus, one glass can be enormous depending on what you're pouring.

SPEAKER_02 22:18

So in Ireland.

SPEAKER_03 22:19

So a standard measure.

SPEAKER_02 22:20

In Ireland, a standard drink contains 10 grams of pure alcohol. So that's roughly half a pint of beer, a single pub measure of spirits, or a small glass of wine.

SPEAKER_03 22:28

Yes. A small glass.

SPEAKER_02 22:30

Yes.

SPEAKER_03 22:31

So not yeah, there should be, I think for a small glass. Yeah.

SPEAKER_02 22:34

I'm gonna ask you a question. How many glasses of wine are in one bottle of wine?

SPEAKER_03 22:37

I know that the answers should be about seven, I think.

SPEAKER_02 22:40

Yeah, how many is it for you?

SPEAKER_03 22:42

Um I'm counting. Probably about five.

SPEAKER_02 22:48

Four or five, yeah. Okay.

SPEAKER_03 22:49

No, five.

SPEAKER_02 22:50

Five.

SPEAKER_03 22:51

I know how many, trust me, I pour.

SPEAKER_02 22:52

So one bottle of wine.

SPEAKER_03 22:54

So I probably give a generous glass.

SPEAKER_02 22:55

Yeah, and most people pour more than that standard glass, right?

SPEAKER_03 22:59

Yeah, but like I'd say most people get about five glasses of wine out of a bottle.

SPEAKER_02 23:03

Fine, okay.

SPEAKER_03 23:03

Now going back to Suzanne, now there'll be all these people going in, geez, Suzanne pours huge bottles, glasses of wine.

SPEAKER_02 23:09

So the same exact thing happens to the breast milk. So whatever's happening to the blood alcohol concentration will happen in the breast milk. So the concentration of alcohol in the breast will increase and peak 60 to 90 minutes after you drink that standard drink, and by two hours it will be gone.

SPEAKER_03 23:30

Yeah.

SPEAKER_02 23:31

Pumping and dumping will not make it go away.

SPEAKER_03 23:33

Nope.

SPEAKER_02 23:34

Drinking more excess water will not make it go away.

SPEAKER_03 23:36

No, it's dependent on you metabolizing that alcohol and then it'll because it moves like across on a concentration gradient and then moves back out again on across a concentration gradient. Exactly. Because milk is magic.

SPEAKER_02 23:49

So, and for each additional unit of alcohol that you drink, you need to add two hours for that formula, right? So one Irish standard drink, it's gone by two hours, roughly. Yeah, two, it's gone by four hours, three, six, and so on. So if you have two to three drinks and you're breastfeeding, your breast milk will contain alcohol for at least six hours. And babies we know don't last six hours.

SPEAKER_03 24:16

No, it depends on their size, yeah.

SPEAKER_02 24:18

No, people will say, Well, I can breastfeed my baby, have a drink, one drink, and then I'll wait for the two hours and breastfeed them two hours later. And that is perfectly reasonable to do.

SPEAKER_03 24:31

Yeah. Myself and one of my friends used to talk about if I had this information back in the day, it would have been lovely to sit down because the babies are quietest and most settled. Yeah. When you're breastfeeding them and immediately afterwards. Yeah. So, like while you're feeding them, in theory, you can sit down and use that to enjoy your small glass of wine.

SPEAKER_02 24:51

Yes.

SPEAKER_03 24:51

Which is actually a very nice idea, I think.

SPEAKER_02 24:53

It is a very nice idea. However, there are a couple of caveats that I would like to add.

SPEAKER_03 24:57

Yes.

SPEAKER_02 24:57

It is really advisable that you avoid alcohol until the baby's at least one month to six weeks old.

SPEAKER_03 25:04

Yeah, fair. Okay. Okay. Because they're teeny tiny and you're trying to establish breastfeeding.

SPEAKER_02 25:09

In fairness, I can't think of mums wanting to have a drink at that time.

SPEAKER_03 25:12

To be honest, yeah, I think they barely can well, I think it at most they might want half an hour so they can shower without crying with the head of an accurate baby.

SPEAKER_02 25:20

There are reasons for that. Let me outline them. First of all, the baby's small, as you said, but also more importantly, breastfeeding has is not really well established until about a month to six weeks. Alcohol can impact breast milk production, and we'll talk about that in a minute.

SPEAKER_03 25:35

Okay.

SPEAKER_02 25:36

The second thing is their feeding patterns are very unpredictable.

SPEAKER_03 25:40

You may have a glass of wine, feed your baby, and then they decide to be stuck to you in about 45 minutes later, just through the peak. Yeah.

SPEAKER_02 25:48

Right. So they have immature livers and they take longer to clear alcohol themselves. If your baby's unwell, if your baby's premature, you need to take that into account. So again, pumping and dumping will not clear alcohol any quicker from your breast milk. The only time I would recommend pumping and dumping, if you are in a situation whereby you had a few drinks, you do not want to use that breast milk to feed your baby, and you don't want to get engorged.

SPEAKER_03 26:13

Yeah, but that's more about managing your risk of mastitis rather than managing the baby's breast milk. That's a different situation.

SPEAKER_02 26:21

The infant dose after one planned drink is usually small, but it's not zero. Nursing after one or two drinks can actually have direct impacts on babies that you will see.

SPEAKER_03 26:32

Yeah. The other thing is that like because alcohol is a drug, yeah, okay, it has a dose and things are dosed by kilo. Tiny, tiny babies, you know what I mean? Like giving any alcohol to them really and they're very, very small is a significant dose for them. Yeah. Relative to like the fact that you're like probably whatever, 30 times their size.

SPEAKER_02 26:56

Yeah, exactly. So we know that babies that uh nurse or feed after the mum has consumed one or two drinks will feed around 20% less. They can be more agitated, they will have poorer sleep, they may be more irritable. So it does have short-term effects on baby.

SPEAKER_00 27:13

Yeah.

SPEAKER_02 27:14

Okay. The long-term effect is what is not clear. What is clear though, and I have looked at this, there is this concern or association between consuming alcohol while breastfeeding and autism and ADHD. And that link is debunked.

SPEAKER_03 27:31

Debunked. Yes. So it doesn't exist.

SPEAKER_02 27:33

It does not exist.

SPEAKER_03 27:34

Thank you. I'm really grateful for you to debunk that.

SPEAKER_02 27:37

I just wanted to bring it up because it does get thrown out. Oh, you'll give your baby ADHD and autism, you won't. We know though, from studies that heavy alcohol use while breastfeeding does have long-term developmental issues on the baby.

SPEAKER_03 27:52

Well, they're ingesting a neurotoxin regularly at doses per kilo that is probably going to be far too great than they can manage. Yes. And like even if you keep the dose very, very low, the long term, it's like us drinking probably more than per kilo we should be drinking every day persistently for a long period of time. You will eventually get the effects of it no matter what, because it's a cumulative exposure.

SPEAKER_02 28:19

Absolutely. So to summarize the effect on the baby, having occasional drinks has no known impact on babies long term.

SPEAKER_03 28:29

Yes.

SPEAKER_02 28:30

Okay. And that's important. However, there are other effects. Alcohol does affect lactation, but not in the positive way that people used to think. People used to think beer increases milk supply. It does not.

SPEAKER_03 28:42

Okay.

SPEAKER_02 28:42

So alcohol is not a galactog. It can decrease milk supply. Five drinks and more can actually almost completely disrupt letdown for a while. Well, it's an antiprolactin agent.

SPEAKER_03 28:53

Okay. Yeah. So that's part of its brain effect is that it decreases the hormones that stimulate lactation. Um I think, yeah, I wonder if that beer help milk milk supply bit come from previous advertising campaigns a long, long time ago.

SPEAKER_02 29:09

Maybe. Yeah.

SPEAKER_03 29:10

And potentially the fact that certain beers had kind of high iron stores in them. Yeah. And the thought was that if you build, if you build up her reserve, the milk will get better. Yeah.

SPEAKER_02 29:20

Sure, up until recently, weren't women getting half a pint of Guinness in the wards for their iron.

SPEAKER_03 29:26

I know.

SPEAKER_02 29:26

Yeah, there you go. So the other issue that people don't often talk about is the caregiving matters as much as milk when you're breastfeeding.

SPEAKER_03 29:33

Yeah.

SPEAKER_02 29:34

Okay. And alcohol risk during breastfeeding, it's not only about milk concentration, it's about the adult caring for the baby.

SPEAKER_03 29:40

Yeah.

SPEAKER_02 29:40

And we know that the risk of SIDS, sudden infant death, increases with alcohol consumption. So you've got to be very careful of bed sharing or sofa sharing or carrying your baby, letting them fall asleep on your chest after consuming alcohol.

SPEAKER_03 29:55

Like any elements of co-sleeping, the risks significantly increase once the caregiver has consumed alcohol. And that's just the way it is.

SPEAKER_02 30:05

That is the most dangerous aspect, in my opinion, of alcohol and breastfeeding.

SPEAKER_03 30:09

Yeah.

SPEAKER_02 30:09

Not the potential exposure to the baby.

SPEAKER_03 30:11

I agree.

SPEAKER_02 30:12

But the impairment of the caregiver.

SPEAKER_03 30:19

And have a glass of wine. And then your sleep is disturbed. Your ability to respond is is influenced because it's it's it's a drug that will put you asleep and impact your ability to respond in a normal way. So I think I think you're right in that. So, you know, whatever about timing and stuff like that, and sitting down and uh having a small glass of wine at an appropriate time when with established breastfeeding, the sleeping component has to be taken into account.

SPEAKER_02 30:50

Yes. So this is why I hate the term and the variations around it. If you're sober enough to hold your baby, you're sober enough to feed your baby because sobriety is so subjective.

SPEAKER_03 31:00

Totally.

SPEAKER_02 31:00

You may think that you're sober.

SPEAKER_03 31:02

But like look at sleep deprivation and reflex response and stuff like that, and your ability to respond. Yeah. Like, and then you put alcohol in on top of that. That's a different issue.

SPEAKER_02 31:11

So anyone giving you that advice, run a mile. And unfortunately, there are a lot of people on Instagram that give that advice. There are prominent data analysts that are giving medical advice about breastfeeding and alcohol, which I think is out of order, to be honest with you.

SPEAKER_03 31:27

Outside of all of the social media stuff, I do think that people can inadvertently contribute to the pressure on people to have a drink at social environment and social situations and stuff like that, out of kindness going, Oh, would you not let her just do what she wants and and and like enjoy her life? Hasn't she abstained for long enough and blah blah blah blah blah? And I think that the point of this pod and today is to just give people the information they need so that if they choose to have a drink, which is an adult decision to make, yeah, that they can put the necessary safeguards in place to minimize any fallout.

SPEAKER_02 32:04

And that's that's exactly my point. I when I have challenged this statement on my social media, I know you get you always get a bit of heat. I get a bit of heat, but I also get a sizable number of women that have messaged me really upset saying that sentence to me gave me the green light to not watch what I'm drinking while I'm breastfeeding. So it is the misinformation. And they say, had I known what you have said, I would have not drank.

SPEAKER_03 32:31

Like women are intelligent, like empathetic people who want to be able to make informed decisions um and decide what's right for them in their life.

SPEAKER_02 32:41

Yeah, but they will listen to reputable or seemingly reputable people on the internet that will say that phrase.

SPEAKER_03 32:48

But I think the intention with that phrase is again to not to to push back against people who shame women for wanting to have a drink.

SPEAKER_01 32:57

Yes.

SPEAKER_03 32:58

And there's nothing wrong with a young mother deciding to sit down and have a glass of wine because my God, it's hard enough.

SPEAKER_01 33:05

Yeah.

SPEAKER_03 33:06

Um but I think being able to do that in an informed way that safeguards you and your baby is key.

SPEAKER_02 33:13

Yeah. And the other false equivalency that I hate is the same people will say that the blood, sorry, the breast milk alcohol concentration after a few drinks is equivalent to what is in normal juice. And I really hate that.

SPEAKER_03 33:30

But juice is not an alcoholic drink.

SPEAKER_02 33:32

Okay, so one study found, for example, that orange, apple, and grape juices contain ethanol up to 0.8 grams per liter. Okay. And breast milk alcohol, when it roughly mirrors blood alcohol, when we said that around one gram per liter of alcohol is what you find. So similar to what is in juice. Therefore, it's fine. Here's my problem with that. You shouldn't give baby juice. And then concentration is not the same as a dose.

SPEAKER_00 33:59

No.

SPEAKER_02 33:59

Right? So dose depends on the milk volume consumed, infant weight, feeding frequency, timing after drinking, and the infant's metabolic maturity. So the concentration is almost irrelevant.

SPEAKER_01 34:10

Yeah.

SPEAKER_02 34:11

Because I might be able to handle a concentration of one gram per liter, but you mightn't. So let's do some practical advice on how to navigate breastfeeding and alcohol.

SPEAKER_03 34:19

Yeah.

SPEAKER_02 34:20

Okay. I would avoid alcohol in the first month while breastfeeding because of the reasons that we apply before.

SPEAKER_03 34:26

Yeah.

SPEAKER_02 34:26

Okay. If you can, feed before drinking. And then ideally, if you want to minimize or eliminate exposure to alcohol by your baby, wait for two hours per standard drink. And obviously that is not always ideal. But if you're only planning on having one drink, feed your baby, drink, hope for the best.

SPEAKER_03 34:49

Yep.

SPEAKER_02 34:49

Okay? Now, if you are planning on more than one or more than two standard drinks, you need to express beforehand so that you have milk or be ready to have formula to give your baby. Do not rely on pumping and dumping to clear alcohol. Only time will clear alcohol.

SPEAKER_03 35:05

Yeah.

SPEAKER_02 35:06

Do not bed share or sofa share after drinking. And make sure there's a sober adult to mind your baby. And do not stop breastfeeding because of one accidental or occasional exposure. All of these ill effects that we talk about is from repeated exposure.

SPEAKER_03 35:20

Yeah.

SPEAKER_02 35:20

And enjoy yourself. So to finish up, alcohol is legal, it's common, it's socially protected, but biology does not care about social acceptability. Around conception, both eggs and sperm may be impacted by alcohol. During pregnancy, there is no proven safe amount, and the safest choice is no alcohol. During breastfeeding, alcohol is not an automatic reason to stop breastfeeding, but it's not nothing. Milk levels follow blood levels, time clears it, pumping doesn't, newborns are more vulnerable, and safe caregiving matters. And remember, this is not about shame. This is about removing alcohol's invisibility cloak. Now go pour yourself an alcohol spritz and enjoy the sunshine.

SPEAKER_03 36:02

An Aperol spritz.

SPEAKER_02 36:03

What did I say?

SPEAKER_03 36:04

Alcohol spritz.

SPEAKER_02 36:05

Yeah, I don't know about these things.

SPEAKER_03 36:08

Enjoy the sunshine, whichever way you choose.

SPEAKER_02 36:11

Talk to you next week.

SPEAKER_00 36:13

This show is part of the Headstuff Podcast Network, a hub for the creative and the curious. Shows are produced in association with Headstuff and the Podcast Studios Dublin. Find out more or become a member at Headstuff Podcasts.com.